1. Arthritis
Depression Focus On
This content is selected and controlled by WebMD’s editorial staff and is brought to you by AstraZeneca.
Health Highlights & Pain July/August 2012
The Right
Moves
Exercise for RA relief p. 2
Mark
Your Calendar
A month of pain management tips p. 3
PainGains
What’s ahead for treatment p. 4
What’s Your
Type?
Test your arthritis smarts p. 6
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2. ask the experts Your questions answered health highlights mark your calendar
The Right Moves Stiff from RA? Exercise is key
Does crack-
ing your
knuckles
cause arthritis?
Q  I’ve had mild to severe chronic
pain in my muscles and joints for two
years now. I manage it with heat thera-
py and avoiding my triggers. But picking
up my 1-year-old baby is starting to agi-
in i&is
Pathr t
Ar
July A month of tips
to boost your arthritis
and pain smarts
Previous page/cover: Fred Froese/Getty Images. left: Sami Sarlis/Getty Images; k-ko/Getty Images
Lots of people, especially tate my chronic pain. What can I do?
children, like the sound of a
good knuckle pop. But you A You could probably benefit by learn-
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
can put your fears aside— ing some new ways to lift and carry your baby 4 5 WARM UP
the idea that knuckle without too much discomfort. (This is a prob- Ease morning
cracking leads to arthritis lem for both moms and dads, by the way.) Juvenile Arthritis Awareness stiffness with
is FALSE. The right physical or occupational therapist Month begins July 1. Discover why a relaxing,
warm shower.
“There have been can help you develop the correct muscles and arthritis isn’t just an older person’s
a few studies on this,” body mechanics to care for your baby with less disease at www.arthritis.org.
says Dimitrios Pappas, pain. At my center we have a baby doll into
MD, assistant professor which we can insert various sized weights. This
of medicine at Columbia allows our patients to simulate doing things 8 LEAN 10 walk on 11 FIGHT PAIN 13 14
Q  I have rheumatoid arthritis and University’s College of with their child by gradually increasing the ON ME To keep joints Ask your doctor about
want to minimize joint stiffness as much If hips, moving, using acetaminophen
cane: Stockbyte/Getty Images; dancing: Antoine Rouleau/Getty Images; man in pain: Stockbyte/Getty Images
Physicians and Surgeons. weights. They learn new ways to move and
knees, or enjoy a or nonsteroidal
as possible. I know I should exercise, “None of them shows any increase their strength.
feet hurt daily anti-inflammatory
but won’t that hurt my joints? change in the occurrence In general, consider using medication when when you walk. drugs to curb pain.
of arthritis between people lifestyle changes aren’t enough to help you reach walk, try
A Exercise may seem counterintuitive, but who habitually crack their your goal of remaining active with your child. a cane.
inactivity further decreases joint motion and knuckles and those who Talk to your doctor
flexibility. It can also lead to weak muscles. do not.” about options, which
16 more 18 19 SPLISH- 20 HAND SAVERS
Salsa SPLASH Buy helpful
Regular exercise helps reduce joint stiffness, But here’s a cool fact: include anti-inflam- This range- gadgets for
Swim in a
builds muscle, and boosts overall fitness. Talk to The “pop” that comes when matory medica- of-motion heated pool opening
your doctor before you begin a new exercise you compress your knuckles tions, certain exercise to ease jars and
helps keep pain and turning
regimen, but here are some general pointers: isn’t from bone snapping on anti-depressant you flexible. strengthen doorknobs.
Choose low-impact aerobics such as water bone. It happens because, and anti-seizure muscles.
aerobics, swimming, walking, and dancing, and as the bones are stretched medications,
cardio machines like the elliptical trainer. Start apart, a gas bubble forms and opioid- 23 WEIGHT WATCHER 25 27 SLEEP SUPPORT
by exercising a few minutes a day, adding more and then pops. based drugs. Maintaining your ideal Need support during
time as you can, until you build up to a moderate While cracking knuckles One note: If you weight relieves stress slumber? Try a full-length
and pain in your body pillow.
pace, 30 to 60 minutes most days of the week. doesn’t lead to arthritis, are breastfeeding or
knees and hips.
Include resistance exercises with or without medical journals do contain are of childbearing
weights two to three times a week to improve reports of people who age, be sure to discuss
muscle strength and mobility. Stronger muscles injured their ligaments any potential medication
provide better support of the joints. Finally, while cracking their additions or changes with
30 HOT 31
To Your Health
regular stretching is important to increase flex- knuckles. At least one study your doctor and pediatrician
ibility and joint motion. also found that the grip of ahead of time. OR COLD
people who habitually crack Use a Read up on the latest treatment news and
cold pack
their knuckles may weaken
to reduce expert tips for dealing with pain. Check out
over the years. Peter Abaci, MD swelling and the Pain Management center at WebMD.com.
Brunilda Nazario, MD WebMD Pain numb pain.
WebMD Health Expert Management Expert
Get expert answers to all your health questions. WebMD.com Ease the pain with tips from the Arthritis center. WebMD.com
2 WebMD the Magazine | July/August 2012 July/August 2012 | WebMD the Magazine 3

3. webMD expert answers to webmd communit y questions
Pain can be an acute event, which that modulate [or adjust] the immune
signals there is harm and you need to
get away from it. Unfortunately, when
We need to response in certain autoimmune dis-
eases, like rheumatoid arthritis, that lead
pain becomes chronic—when it’s
present for long periods of time after
think about to chronic pain. Some of these are show-
ing promise.
the tissue has healed—we can still have
this perception of pain even though pain as a Researchers are working on gene
therapy approaches to chronic pain,
there is no obvious tissue damage or
injury. At that point, pain fundamentally disease in its using viruses to turn on and off our
own internal chemical plants to release
causes rewiring and alterations in our pain-relieving substances. An example
nervous system.
We need to think about pain as a
own right— of this is when you get a runner’s high:
You can have gene therapy that turns
disease in its own right—much like any
other chronic disease, such as diabetes,
much like any that on continuously. These are still in
the early stages, but they hold promise.
asthma, or heart disease.
other chronic Scientists are investigating different
ways of implanting stimulators into
2 disease.
What are common our nervous system and into our brain
myths about pain? to turn off the signals responsible for
Gains
One is that it’s all in your head. This pain. I think we’re going to be seeing
has some basis in truth, but we have to be exciting treatments for chronic pain in
careful. Yes, pain is all in our brain, but the future.
that doesn’t mean it’s made up. I spend
5
a lot of time with my patients validating cures for the pain, but we have found What do we now know
their experience of pain and then help- wonderful ways to manage it. about pain that we
ing them understand how pain really is didn’t know a few
3
influenced in the brain by a multitude Is chronic pain years ago?
of factors—stress, anger, catastrophizing, different for men The mind and body are very linked, and
anxiety, belief systems, expectations—all and women? research is showing that linkage more
An expert explains why you’re really aching of these play a significant role in our
experience of pain.
Yes. This is a hot topic right now. What
we know is there’s a larger percentage of
and more.
We have technology [a type of MRI
and what’s ahead for treatment Another myth is that you have to
live with it. We need to first find out if
women who experience chronic pain—
the data in my clinic is two-thirds women
scan called fMRI, or functional magnetic
resonance imaging] that allows us to
there are any medical causes that can to one-third men. Women are more likely focus on a specific region of the brain
1
By Christina Boufis, WebMD Contributing Writer What is pain? be corrected for someone’s pain, so to get certain chronic painful conditions, responsible for the perception of pain.
Pain is such a simple word, but the it’s not just a matter of telling some- such as fibromyalgia and irritable bowel We had people think about their
As with other subjective experiences, such as problem is that what people think one you have to live with it. But it’s syndrome. Some conditions tend to affect chronic pain as being this terrible, hor-
it means is not really what it means. All up to us physicians to show people men more, such as cluster headaches. rific experience. Then we asked them to
love, fear, or anger, there’s no way to objectively of my patients tend to associate what’s how to best manage that pain, whether Women are also more sensitive think about it in a calming, soothing,
going on in their arm or their back as through medication, surgery, physical to experimentally evoked pain (pain pleasant manner. We found their brain
measure pain. We asked Sean Mackey, MD, PhD, pain out there in the body. But it’s not. It’s and occupational therapy, or mind/body produced in a laboratory or research activity went up and went down as a
something we call nociception—electro- approaches—all of these show signifi- study)—heat, cold, electrical stimuli, consequence. They could see their brain
chief of the Pain Management Division and chemical signals generated in our body cant benefit in reducing patients’ pain pressure. But we have to be careful not activity, and over time they would even-
in response to injury that get transmitted and helping them improve quality of life to interpret this increase to mean that tually learn how to control a specific
associate professor of anesthesia at Stanford along nerve fibers to our spinal cord and and physical functioning. women are weaker than men because area of their brain and their pain.
up to our brain, where they’re processed One other myth is that patients there are genetic, hormonal, and cen- Even so, we’re still predominantly
University School of Medicine, to explain the and become the experience of pain. sometimes think medication is going to tral brain differences in women that we using fMRI as a way of better
For example, if you cut your finger, cure pain. Most of the time, medications believe may be playing a role. understanding the brain and its
unpleasant sensation we all feel in different ways. that’s not pain in your finger, that’s help reduce or alleviate patients’ pain, relationship to pain, but it’s not yet
4
nociception. But nociception is such a but in very few cases do they have What promising new ready for prime time as a treatment.
Reviewed by terrible word; it doesn’t exactly roll off disease-modifying properties. The truth drugs or treatments We’re just at the tip of the iceberg in
Louise Chang, MD the tongue, and it’s not easy for people is, for many of these chronic painful are on the horizon? understanding the role of the brain in
WebMD senior MEDICAL EDITOR to remember. conditions, we haven’t found specific There are drugs under investigation pain.
Get the latest news about chronic pain treament. WebMD.com
4 WebMD the Magazine | July/August 2012 July/August 2012 | WebMD the Magazine 5

4. pain pain
Did you know? Did you know?
Women People with
are more chronic pain
likely are at risk for
than men sleep disorders
to have and depression.
What is your arthritis. how much do you know
arthritis type? about chronic pain?
Samm73 has had “joint tenderness” in both index For the millions of people who live with chronic pain,
fingers, both thumbs, and two toes. “The pain lets the social and emotional effects are sometimes as
up once in awhile, but becomes worse throughout bad as the physical sensations. “I know that I’ve
Questions Questions
the day depending what I’m doing,” Samm73 wrote been judged by other people who do not understand
recently in the WebMD osteoarthritis community. or want to understand what life is like with
“Does this sound like osteoarthritis?” Samm73 fibromyalgia,” ggladieux writes in the WebMD pain
has symptoms of both rheumatoid arthritis and management community. “My sister-in-law thinks
osteoarthritis, so he needs to see a doctor for the I’m just being lazy. Believe me, I wish it were that
correct diagnosis. Do you know the symptoms of these
two conditions? 1How did you determine what type of arthritis
I have?
simple, but it isn’t.” How much do you know about
chronic pain? Take the quiz to find out. 1 What is causing my chronic pain? Should I see
a specialist?
Osteoarthritis:

Aching joints, especially with movement and most often
relieved with rest
2 What kind of medication will work best for
me and my lifestyle?
● Migraines and severe headaches are most common
1
among postmenopausal women.

True 
False
2 Will medication, steroid injections, or surgery
help my type of pain?
 orning stiffness or after resting for an extended period of
M
time, generally lasting less than 30 minutes
 ain, most commonly in the hands, spine, hips, or knees
P
3 What kind of exercise is best for me? How
often should I exercise? ● The to osteoarthritis.most common site of joint pain
2
due
shoulder is the 3 Are there alternative therapies that can help me?
What about exercise?
 ony growths near finger joints
B
 Creaking” or grating joints, accompanied by pain
“ 4 Are there any nutritional supplements or over-
the-counter treatments that can help me?

True 
False
4 Can counseling help me address pain-related
emotional issues?
Rheumatoid Arthritis: ● Backmonth. chronic if it persists for more than
3
one
pain is
 oint pain, warmth, and swelling; the same joints on both
J
sides of the body are usually affected chronic pain 
True 
False chronic pain
 tiffness, especially for more than an hour in the morning or
S newsletter newsletter
after resting for long periods
Sign up for the latest news
● Uncontrolled diabetes can lead to chronic pain.
4
Sign up for the latest news
 oint pain most commonly in the hands, wrists, and feet
J 
True 
False
and lifestyle management and lifestyle management
 atigue and weakness
F Answers: 1. False. These headaches are most common during women’s
 ainless lumps or nodules under the skin of the elbows,
P
tips—delivered directly to childbearing years. Migraines and severe headaches affect twice as many
tips—delivered directly to
spine, or other pressure points your email inbox! Go to women as men—21% compared to 10%. 2. False. The most common sites your email inbox! Go to
WebMD.com and search of joint pain due to osteoarthritis are the knees, hips, and hands. But OA WebMD.com and search
 eight loss, low-grade fever
W can also affect the shoulders. 3. False. Doctors consider back pain “chronic”
for “newsletters.” if it lasts for more than three months. 4. True. Uncontrolled diabetes can for “newsletters.”
lead to nerve damage that leads to chronic pain in hands, arms, feet, legs,
and other areas.
Source: Centers for Disease Control and Prevention, the Arthritis Foundation, and the
arthritis SEARCH
RCH
Source: Centers for Disease Control and Prevention, National Institute of Neurological
pain relief SEARCH
RCH
Arthritis Health Center Disorders and Stroke, and the Pain Management Health Center
6 WebMD the Magazine | July/August 2012 July/August 2012 | WebMD the Magazine 7